1986-178 BUILDING PERMIT
TOWN OF QUEENSBURY a
No. 86-178
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Joe Roulier
OWNER of property located at Lot 119 Sugar Pine Road (St. No. 3) Street,Road or Ave.
The Pines of Queensbury
in the Town of Queensbury,To Construct or place a One—Family Dwelling =
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. r'+
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1. OWNER'S Address is Box 301
Cleverdale, New York 12820
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2. CONTRACTOR or BUILDERS Name
same
3. CONTRACTOR or BUILDERS Address
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4. ARCHITECT'S Name 1.0
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5. ARCHITECT'S Address Fro+.
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8. TYPE of Construction—(Please indicate by X)
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(xl Wood Frame ( )Masonry 1 )Steel
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7. PLANS and Specifications
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64'x36' per plot plan, specifications and application w
No. submitted including two—car attached garage and sewage v
system. o
8. Proposed Use M
One-Family Dwelling
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$5.00 C/O Paid d
$ 171.00 PERMIT FEE PAID—THIS PERMIT EXPIRES November 1 1986
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this 30th Day of April 19 86
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
7O BE COMPLETED BY BLDG. DEPT.
Application No.
Own oi9 Queenitury Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires 19 � I��`
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation (� 6 '
Oueensbury, New York 12801 variance No. I
9 O ? - Site Plan Review No. /Q'1 R 1 4t:i) /
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Approved by: a rrd.C. ,q o�
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APPLICATION FOR w r/13/U Tv .7J5Jaggw12M 401 /5j6
BUILDING AND ZONING PERMIT
* * * * * * * * * * * * * * * * * * * * * * * * * * * # * * * * * * * * * •:.*
A PERMIT MUST BE OBTAINED BEFORE BEGINJING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a Building Permit to do the following work which will
be done in accordance with the description, plans and specifications submitted, and such
special conditions as may be indicates on/ the Permit. ''''''///II1
The owner of this property is: �,/, *v6 ri !y
P.O. Address /} .x ,3e/ ,, teee../CL< "de. a, , . % two 7" Tel-L+L- 33cyy
Property Location: i S.yyn 7/ 7II . %t ,1 �.e... /, Tax Map No. 7a/ ft ///S
Street number or bbbuildiig lot number
Subdivision name (if applicable) ., 1 ./ u (.,�
THE PERSON RESPONSIBLE FOR SUPERVISION OF W(5R1C AS REGARDS BUILDING BUILDING CODES IS:
7��.1; �,r 3. // ,/l. yee (< .✓. y G,G- 3i YY
Name P.O. Address / Tel. No.
Name of builder ' Address dr avid/ Tel.
Name of plumber �t / 4., Address,'. z fa/.*,../(N.yTel. 2.ep- etT3
Name of mason "IC-. s:Lv* Address ,C v .x J „ . Tel. 7Se - es??
NATURE OF PROPOSED WORK: * ZONING INFORMATION:
✓Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
Addition to a building * drawn reasonably to scale and attached hereto,
Alteration to a building * showing clearly and distinctly all buildings,_
(no change to exterior dimensions) * whether existing or proposed and indicate all
Other work (describe) * set-back dimensions from property lines. Give
* street and number or lot number and indicate
FOR *DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
LOCATION OF STRUCTURES AFFECTED. of water supply and location and configuration
* of septic disposal area.
*
* COMPLETE INFORMATION REWIRED BELOW. /70
* Size of property / ' ft X X ft.
* Existing building(s) Size ft X ft.
*
PROPOSED BUILDING AND USE:
* Existing building(s) Use
Size of new structure G y ft X ,3( ft *
Foundation-pier/slab/crawl/partial ® * Proposed building, distance from property line
(circle one) *
No. of stories (habitable space) e1 * Front yard .. ea_ ft Rear yard y)y ft
Height (grade to ridge) ^- Jy ft. * Side yards 33 ft and .., 3 g ft
If residential, no. of families / * If on corner, setback from side street ft
No. of rooms(excluding baths) ? * OCCUPANCY INFORMATION
No. of bedrooms r *
No. of bathrooms * PRIIAARY BUILDING -
`l'�i ''One family dwelling
Primary heating system £/ *
* _Two family dwelling
Type of fuel �,
Multiple dwelling / Number of units
No. of fireplaces to be installed ../
* Permanent occupancy
Will a wood stove be installed? q/o *
Central Air conditioning? /„a * Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Log cabin * Other o
Raised ranch Mansion Duplex * If addition, what will use be.
Split level Old style Bungalow *
Cape Cod Cottage Other * ACCESSORY BUILDING-
CColonia5C Row Town House Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/ of car
* * * * * * * * * * * * * * * * * * _Private storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION *
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
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BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc. s:AC N
Will any second-hand or ungraded lumber be used? If so, for what? m/a
Foundation wall material <..,....: 3(..K Thickness e- f,Je
Depth of foundation below grade (to bottom of footing)// .,,a ,
Will there be a cellar? Heated or unheated? u.✓'r.C.TFloor sq. footage -A //e+r- sq ft
Will there be a basement? " Will any portion be used as living space? AA*
(If so, what portion? sq.ft. - - Type of use?
Type of roof - sloped/flat/shed/other...Y.':o<c/ Material of roof .os0{z! Sf. 4 s
Size, wood studs ,�,j "X C " spacing .3y/'o.c. length S'CV(fi. / I
Joists(floor beams) 1st. floor eZ "X ,lp " spacing -- "o.c. span /,3 ft.
Joists (floor beams) 2nd. floor 04 "X /o " spacing -in "o.c. span / q ft.
Overlays(ceiling beams) p( "X y " spacing .,y"o.c. span/,j ft.
Roof trusses(pre-engineered) spacing ay "o.c. spane/( ft.
Exterior wall finish „q,.;i Of what material? Ceeepi
Interior wall finish .—7_ (
If a garage is_tp be attached, describe materials to be used for FIRE. SEPARATION:
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Is there to be an opening between garage and dwelling? j'e3 If o will a Fire-rated
door, enclosure, and self-closing device b provided? y y (�. c :
Will a flue-lined chimney be installed? Ye Height above roof 1 J. ft.
Depth of chimney foundation below grade 47 ft.
Depth of fireplace hearth _04 ft. in.
Water supply - Municipal or private well /. C
SEPTIC SYSTEM Distance from ANY private well(idcluding adjoining properties ft.
(A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury
County of warren AFFIDAVIT STATE OF NEW YORK
I swear that to the best of my knowledge and belief the statements contained
in this application, together with the plans and specifications submitted, are a true and
complete statement of all proposed work to be done on the described premises and that all
provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertaining to
the proposed work shall be complied with, whether specified or not, and that such work is
authorized by the owner. 7
SWORN TO BEFORE ME THIS Signature J " ��
Owner, owner's a ent,arcnitect,contractor
/J day of IA.? 19 47[
Notary Public, Warren County, N.Y. s
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL COrb,TIONS OF THE PERMIT:
By
Joan of Quandary
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, RD. 1 Boa 98
Oueensbury, New York 12801
SEPTIICC DISPOSAL PERMIT APPLICATION
Owner 's Name _E27 cr. Tel. 4..7C - 33 vy
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Address �r 3o j � .... .46 ili . y it?. z•
Person/Firm installing system �qic �f�e..aa / cic .
Number of bedrooms(residential only) y
Total daily flow: (compute @ 150 cal.per bedroom per day)_ ea-r,
Topography fla rolling - steep - (circle one) Degree of slope o %
Nature of soils:(sand7loam-clay- other- Depth ft.
Ground water-- at what depth? -- ft.
Bedrock or impervious material--at what depth? r' ft.
Percolation Test - Not required / Required -Rate min/inch.
Domestic Water Supply cunicipai Well - Other
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IMPORTANT !
On a separate piece of paper , submit a diagram of the proposed septic
system with all dimensions; including distance from any structure,
distance from property lines and distances from amx domestic water
supply or shore-line of lake, stream, pond or wetlands. Include all
dimensions of the system itself. Sew 04,— /J1.,)
Description of proposed system:
Septic tank size ,o as gal.
Tile field- Length of each trench s/a ft. Total field .,'a ft.
Size of stone # DI
Seepage Pit (s) Number / Size ftX__ft. Size of stone#_ •
Any contractor, corporation, individual ,Etc. , engaged in the
construction of a Sanitary Sewage Disposal System, who covers the
same before inspection, does not have an approved Permit, or varies
from the approved application, will be subject to a Penalty of $250
as provided for in Section 6. 010 of the Town of Queensbury Sanitary
Sewage Ordinance.
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Signature of Applicant / Date
01/86 and/vl
Septic System Inspections:
A. All applications for septic system installation,
alteration or repair, as required by the Town of
Queensbury Sanitary Sewage Ordinance, shall be
submitted to the Building Department at least
24 hours before start of construction and shall
include a plot plan showing:
1) the proposed location of the system
2) location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution
boxes, tile fields and/or drywells
B. Ng system shall be covered before inspection and
approval by the Building Inspector. Failure to
comply with this requirement may result in the
uncovering of the system by the installer and a
fine of up to $250.00.
C. An approved copy of the plot plan shall be
available .on the construction site. Failure
to produce said plot plan at time of inspection
may result in an immediate work stoppage.
D. Should unforeseen problems during construction
prevent proper installation, alteration or
repair of an approved system, a new proposal
must be submitted to the pueensbury Building
Department before further construction.
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Application for: BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work.
ANSWER ALL of the following:
1. Gross floor area
2 . Type of heat f� c
3 . Is the building mechanically cooled? No .
4. Percentage of area of windows and doors
A. Over 16% Only
1 . Uo value of gross area of walls , roof/ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a. Are foundation walls insulated? YES NO
1 . If YES, what is the R value?
3 . Slab on grade YES NO
a. If YES, what is the R value of insulation around
perimeter of floor?
4 . Is basement heated? YES NO
a. R value of insulation
5. Type of insulation
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions_
�0 2� 9"
2 . R value of exterior walls /9 -
3. R value of glazed area e1.
4. R value of doors A.1 1/
5 . R value of floors over unheated spaces of
6. R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab
8. R value of heated basement/cellar walls (above grade) - D
9. R value of heated basement/cellar walls (below grade)
10. Type of insulation ,.<l jZ,:s `"
C. Controls
1. Thermostat maximum heat setting (7d
D. Duct Systems
1. Is duct system installed in unheated spaces? YES NO
a. If YES , R value of duct installation
b. R value of duct in other areas
E. Piping Insulation
1. Size of hot water or cooling carrying agent pipe
2. R value of pipe insulation O
F. Service Water Heating
1 . Performance efficiency J�;hh fr/F,rtiy
2 . Temperature control setting maxi/num
G. For Swimming Pool Only
1 . Maximum heating
Telephone No. dot - 3 :'Vy
(appli ant ' s signature)
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Alban` m
✓own of Queensbury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR'S REPORT
NAME _co e pc( /1 ev I
Sufi' S- in •e
74OCAT ION Lar Jl 9 ?me' 4/.
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Date / �/a /j O0 Permit No. 0 — I70m
* * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES J*NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
✓ Framing St I^yyrn0'A,62
Roofing
Siding
Masonry Veneer
v Rough Plumbing Q`"
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar_ Fireproofing
Door Closers
Smoke Detectors
Chimney
y INSULATION: i
Foundation
Floors
Walls 12C
Ceiling /Ott,
FINAL ELECTRICAL INSPECTION
Final Building Survey
Next scheduled Inspection(call when ready)
Remarks- - 0p r- as[/, tl "ale,' jet
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Building Inspe
6/86 and-vl
TOWN OF QUEENSBURYA'
Building Department
Impactors Date rsyl-f• Qfrc
Name
Location �, f�."•...
Permit No. 84 - / 7 8 Weather
Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing �r
Backfill bi(
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile ::\I)cs\\
Concrete Floors
Plbg. Fixtures
_ Car. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation Foundation
Walls
Ceiling
111 Building Inspector
REMARKS
TOWN OF QUEENSBURY
Building- Department
hupec[mLocativeaDate Y /7 • '6 Y2
Name c
Permit . 1 Weather
yG - i7b' Remarks
Excavation
Footing Forms
Footing & Piers v,tc_
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation Foundation
Walls
Ceiling
f 15,$5
Building Inspector
REMARKS
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